Thryoid Storm Diagnosis

Aka: Thryoid Storm Diagnosis, Burch Wartofsky Score

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II. Indications

  1. Hyperthyroidism with suspected Thyroid Storm

III. Criteria

  1. Thermoregulatory dysfunction
    1. Score 5: Temp 99 to 99.9 F
    2. Score 10: Temp 100 to 100.9 F
    3. Score 15: Temp 101 to 101.9 F
    4. Score 20: Temp 102 to 102.9 F
    5. Score 25: Temp 103 to 103.9 F
    6. Score 30: Temp >104 F
  2. Central Nervous System Effects
    1. Score 0: Absent
    2. Score 10: Mild (e.g. Agitation)
    3. Score 20: Moderate (e.g. Delirium, Psychosis, severe lethargy)
    4. Score 30: Severe (e.g. Seizure, coma)
  3. Gastrointestinal-Hepatic Dysfunction
    1. Score 0: Absent
    2. Score 10: Moderate (e.g. Diarrhea, Nausea or Vomiting, Abdominal Pain)
    3. Score 20: Severe (e.g. unexplained Jaundice)
  4. Cardiovascular Dysfunction
    1. Score 5: Pulse 90 to 109
    2. Score 10: Pulse 110 to 119
    3. Score 15: Pulse 120 to 129
    4. Score 20: Pulse 130 to 139
    5. Score 25: Pulse >140
  5. Congestive Heart Failure Dysfunction
    1. Score 0: Absent
    2. Score 10: Mild (e.g. pedal edema)
    3. Score 20: Moderate (e.g. bibasilar rales)
    4. Score 30: Severe (e.g. Pulmonary Edema)
  6. Atrial Fibrillation
    1. Score 0: Absent
    2. Score 10: Present
  7. Precipitant History
    1. Score 0: Absent
    2. Score 10: Present

IV. Interpretation

  1. Score 45+: Thyroid Storm
  2. Score 25 to 44: Impending Thyroid Storm
  3. Score <25: Unlikely to be Thyroid Storm

V. References

  1. Burch (1993) Endocrinol Metab Clin North Am 22(2): 263-77 [PubMed]

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